The University Of Oklahoma Foreign National Information Form (1 of...

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The University Of Oklahoma Foreign National Information Form (1 of 2 pages) updated 07/04

The information provided on this form will be used to determine your eligibility for non-resident tax treaty benefits and your income tax obligation while working for the University of Oklahoma. Return the completed ORIGINAL form to the Office of Human Resources, NEL 244. Be sure to attach copies of:

(1)

both sides of your I-94 form (arrival and departure record);

(2)

your U.S. visa and passport number from your passport;

(3)

your I-20 for F-1 visa or DS2019 for J-1 visa or I-797A for H-1 visa;.

(4)

a copy of your social security card if you have one. Questions? Call the Payroll office at ( 405) 325 - 2961. Applicant's Information Last or Family Name: First: Social Security Number or ITIN#: Date of Birth (MM/DD/YYY): US Local Street Address ( Street, City, State, and Postal Code): Middle: Student ID Number: Foreign Residence Address (Street, City, State, and Postal Code): Country of Citizenship: Country that issued Passport: Passport #: Passport Expiration Date (MM/DD/YYY): Immigration Status? (check one): J-1 Exchange Visitor H-1 Temporary Employee F-1 Student Other. What type? If you hold a J-1 Exchange Visitor, what is category? (check one): Student Short Term Scholar Professor Specialist Research Scholar What is your primary activity of the visit to the US? (check one): Studying in a Degree Program Studying in a Non-Degree Program Observing Conducting Research Teaching Lecturing Consulting Temporary Employment If you are a student, what is your status? (check one): Undergraduate Doctoral Masters Other. What Type? Visa #: Training Demonstrating Special Skills Clinical Activities With Spouse

The University Of Oklahoma Foreign National Information Form (2 of 2 pages)

Last or Family Name: First: Middle: What is the actual date you entered the U.S.? (The first time you entered the U.S.) Date (MM/DD/YYYY): What is the beginning date that you started the above primary activity in the U.S.? What is the projected end date of you primary activity in the U.S.? Is your spouse with you in the U.S.? How many of your children with you in the U.S.? Yes No No spouse. Number: No children. Please list any visa immigration activity in last three calendar years and all F, J, M or Q visas since January 1, 1985: Date of Entry MM/DD/YYYY Date of Exit MM/DD/YYYY Immigration Visa Type Primary Activity Tax Treaty Benefit? Yes No Yes No Yes Yes No No Yes Yes No No Yes No I hereby certify that all of the above information is true and correct. I understand that if my immigration status changes from that which I have indicted on this form, I must submit a new Foreign National Information Form to the Payroll Department. Signature Date The university complies with the Privacy Act of 1974, 5 U.S.C. § 552a(b), including updates and exceptions.

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